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This document provides interim guidance specific for homeless shelters during the outbreak of novel influenza A (H1N1) virus and suggested means to reduce the spread of influenza in these settings and communities. Recommendations may need to be revised as more information becomes available.

Background

Shelters that serve homeless persons can help protect the health of their clients, staff and volunteers during this outbreak of novel influenza A (H1N1) by taking actions to prevent the spread of influenza. The homeless population is diverse, transient, and includes single adults, children and families. Much of the homeless population is sheltered, but over 40% of them are unsheltered. In addition, events such as acts of nature (e.g., hurricanes), reduced access to everyday resources, or a disease outbreak may contribute to a rapid increase in emergency shelter usage. Interim recommendations to reduce transmission of novel influenza A (H1N1) virus in this group setting are addressed below.

Influenza-like Illness (ILI) and Novel Influenza A (H1N1)

Novel influenza A (H1N1) virus is likely to spread from person to person in the same way as seasonal flu. The main way that influenza is thought to spread is through the coughing or sneezing of people infected with the influenza virus. People may also become infected by touching something with flu viruses on it and then touching their mouth, nose, or eyes.

Symptoms

Symptoms of influenza-like-illness (ILI) include fever and either cough or sore throat. In addition, illness may be accompanied by other symptoms including headache, tiredness, runny or stuffy nose, chills, body aches, diarrhea, and vomiting. Like seasonal flu, novel influenza A (H1N1) infection in humans can vary in severity from mild to severe. For more information on the symptoms of novel influenza A (H1N1), please see CDC What to Do If You Get Flu-Like Symptoms.

Transmission

Spread of this novel influenza A (H1N1) virus is thought to occur in the same way that seasonal flu spreads. Flu viruses are thought to spread mainly from person to person through coughing or sneezing by people with influenza. In addition, people may become infected by touching something with flu viruses on it and then touching their mouth or nose.

Make the means for appropriate hand cleansing readily available within the shelter, including common, food preparation and dining areas. Ideal means for hand cleansing include, running water, soap, and hand drying machines. Paper towels and waste baskets should be made available. Shelter staff, volunteers and clients should frequently wash their hands with soap and water, or use a hand sanitizer* if hand washing with soap and water is not possible.

Shelters should follow standard precautions in the shelter settings. This includes training staff in the control of infectious diseases, providing access to personal protective equipment and apparel, and encouraging proper hand washing. For more information on standard precautions in health care settings, please see Shelter Health: Essentials of Care for People Living in Shelter. Items that are often in contact with respiratory droplets and hands (e.g., doorknobs, faucets, etc.,) should be cleaned and disinfected regularly. For more information, please see CDC Clean Hands Save Lives!

Clean all common areas within the shelter routinely and immediately, when visibly soiled, with the cleaning agents normally used in these areas. Eating utensils should be washed either in a dishwasher or by hand with detergent and water. Cups and utensils should not be shared until after washing.

Shelter clients, staff and volunteers should be instructed to immediately inform shelter management if they have an influenza-like illness (ILI) or if they have had one in the previous 7 days.

Direct persons with ILI symptoms to facilities or alternative care sites (ACS) where they can receive proper care, if such alternatives are available. Please see Pandemic Flu Healthcare Planning.

Staff and volunteers with ILI should stay home (or be sent home if they develop symptoms while at the shelter), and remain at home for at least 24 hours after their fever is gone except to get medical care or for other necessities (their fever should be gone without the use of a fever-reducing medicine). They should keep away from others as much as possible. This is to keep from making others sick.

Actively monitor the number and severity of cases of ILI and inform the state, local, tribal, or territorial health departments of cases at the shelter.

Ideally, sick persons should be confined to individual rooms and should avoid common areas. If individual rooms for sick clients are not available, consider using a large, well-ventilated room specifically for sick persons with beds at least 6 feet apart and the use of temporary barriers between beds, when possible.

Designate staff to care for the sick persons and limit client movement between different parts of the institution to decrease the risk of spreading influenza to other parts of the shelter.

Provide sick clients with access to fluids, tissues, plastic bags for the proper disposal of used tissues, and a means to wash their hands or alcohol-based hand sanitizers as an adjunct.

Linens, eating utensils, and dishes belonging to those who are sick do not need to be cleaned separately, but they should not be shared without thorough washing. Linens (such as bed sheets and towels) should be washed using laundry soap and tumbled dry on a hot setting. Individuals should wash their hands with soap and water or use alcohol-based hand sanitizer immediately after handling dirty laundry.

Caring for Persons at High Risk

The shelter should be aware of the special health needs of persons at increased risk of severe illness from influenza.
Persons at high risk for complications from novel influenza A (H1N1) infection may be similar to those who are at high risk for seasonal influenza complications and include the following: children 5 years and younger, persons age 65 years and older, pregnant women, persons of any age with chronic medical conditions (such as asthma, diabetes, or heart disease), and persons who are immunocompromised (for example, taking immunosuppressive medications or infected with HIV). Information on the aforementioned high risk populations can be found at the following links: Pregnant Women and Novel Influenza A (H1N1) Considerations for Clinicians